Primary healthcare and need for legislative intervention
The major role of primary health care is to provide continuous and comprehensive care to patients in order to attain better health services for all.
The delivery of quality primary health care services can have a large impact on the health of Nigerians.
To ensure this, health stakeholders have called for urgent revitalisation of the Primary Healthcare Centres, PHCs across the country, noting that this will drive socio-economic development.
Making this call recently in Lagos after a facility visit of some lawmakers and Civil Society Organisation, CSO activists to Powerline Primary Healthcare Centre and Soretire Orile-Agege Primary Healthcare Centre, both at Agege Local Government Area, Lagos State.
The site visit was part of the ‘South West Policy Dialogue,’ under a project titled, "Reinvestment: Increasing Legislative Oversight on Primary Health Care in Nigeria,” organised by Civil Society Legislative Advocacy Centre, CISLAC in Lagos.
The dialogue was aimed at providing enabling platform for all-inclusive recommendations in revitalising PHCs to ensure appropriate legislations and policy directions in the country, after first-hand visits to PHC sites.
Article 25 of the Universal Declaration on Human Rights states, "Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services."
To this effect, the legislators, members of House of Representatives and activists from, CISLAC stressed that revitalisation of PHCs’ goes beyond refurbishing of old buildings and buying new equipment.
According to them, this is an important first step in setting up health systems that work, though, it is not the only step needed.
However, they lamented that paucity of funding is affecting PHC revitalisation in the country which is worsened by poor budgetary allocation to health.
For instance, the budget allocated to health which was four per cent in 2016 and 2017 only increased marginally from 4.4 to 4.75 per cent in 2018 and 2019 respectively, but shows a sharp drop at 4.14 per cent in the 2020 proposal.
Similarly, the commencement of Basic Health Care Provision Fund, BHCPF, implementation in 2019 put at N51.22 billion also shows a sharp decline to N44.50 billion in the 2020 budget proposal.
Making his presentation at the occasion, Dr Francis Ahanyido, a public health physician, in his presentation stated there is a correlation between healthy citizenry and wealthy nations; even as he called for urgent revitalisation of the primary healthcare system.
Ahanyido further stated that workable machinery such as comprehensive insurance scheme needed to be in place, a structure that protects everybody, both the rich and the poor.
For example, if a street cleaner gets sick, she might not be able to pay for her treatment.
And even if she goes for a loan to treat herself or her child, paying back such loans would mean her entire family has to go without food and other needs for a very long period.
And therefore, it is very necessary to put in place a scheme that gives everybody protection, he insisted.
He further stated that CISLAC has been able to activate the passage of national health act of one per cent consolidated revenue which has been included in the budget.
According to Ohanyido, the money may not be much, but at least it shows commitment on the side of the federal government.
The states and local governments also need to play their own part because the federal government can’t do everything, he added.
Prof. Akin Abayomi, Lagos State Commissioner for Health, reiterated the government's plan to restructure healthcare in order to restore public confidence.
The commissioner, who was represented by the permanent secretary of the Lagos State Primary Health Care Board, Dr. Tayo Lawal, also said that poor funding and medical personnel are major challenges facing effective primary healthcare in the country.
The health boss said, “Lagos states has like 360 primary healthcare centres, the role of maintaining and managing these centres is very critical.”
According to Dr. Samuel Adejare, the Deputy Chairman, House Committee on Health, representing Agege constituency, “We as Legislators make laws that would support health workers in PHCs’ to be mobilised to work effectively and functionally. If we should have a concise number of PHC's that are highly functional, it will help Nigeria a whole lot.”
The lawmaker tasked his colleagues to sponsor bills that will help improve PHC's in the country, to better the lives of Nigerians and avoid needless deaths from preventable as well as avoidable diseases.
Also speaking, Dr. Jubril Bashar from the Health Policy and System Development Unit, Ahmadu Bello University, Zaria, said the minimum standard for primary healthcare in Nigeria which has been in existence was revised some time in 2006, but a number of people are not aware of it.
He said, “The programme is aimed at sensitising especially, the legislative arm of government to see that the need for a functional primary healthcare was achieved. This is particularly so now that we are talking about revitalising healthcare and actualising functional primary healthcare in the country - that is the concept of a standard primary healthcare.
Bashar said, “It is not rocket science. If the political will is there, it will not be a difficult thing to do. Revitalising the primary healthcare is possible. Already, many things are coming on board, State are signing, funds are being made available some States are going into partnerships with private sectors and are preparing analysis. Some States are even talking about the contributory state healthcare financing - these are other sources of income and with the federal declaration of minimum of 15 per cent of the annual budget to be allocated to health, it will go a long way if there is compliance.”
He added that primary healthcare in Nigeria is less than what is expected even for the downtrodden, the poor and those that cannot afford standard quality healthcare.
“If everyone is aware that primary healthcare is not just for the poor, but everyone, they would start accessing primary healthcare before going to the higher levels of secondary and tertiary healthcare.”
Chioma Kanu, Programme Manager for Health with CISLAC, said, “That the essence of this retreat is for the Legislative members to start thinking about how they can actually move the health sector forward from where it is. Actually, primary health care is the first point of call for all the masses. The Secondary and Tertiary health care are known majorly for specific big health issues.
“The site seeing is for our law makers to come and see what these PHC's look like and make serious commitment to putting things in place. At least, let us have some primary healthcare centres if not all that are up to the minimum standard of primary healthcare.”
Kanu said, "with the national assembly and representatives on revitalizing health care. Two regions among the six geopolitical zones in Nigeria, have been visited like the South-east and south-south and then this is the south-west part.
"We still have North-east, North central and North West; normally we take these law makers to some primary health care facilities so they can have a feel of what the places look like so that they will be able to perform their oversight function in the relevant department and ministries with the hope to raise the standard of primary health care in Nigeria."
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